18 Questions
What is the preferred test to visualize clots in the pulmonary artery?
CT pulmonary angiogram
Which test is used for high probability of a pulmonary embolism?
CT pulmonary angiogram
In diagnosing a pulmonary embolism, what indicates a low-risk PE?
Normal blood pressure
What treatment is recommended for stable patients with pulmonary embolism?
Anticoagulation
Which test is used for diagnosing a pulmonary embolism in patients with moderate probability?
D-dimer with CT pulmonary angiogram
What indicates a massive PE burden?
RV dilation or dysfunction
In DVT treatment, what is the approach for massive proximal DVT?
Catheter-directed thrombolysis
How is PE further classified based on echocardiogram findings?
Submassive PE for normal RV dilation
What is recommended for hemodynamically unstable patients with massive PE?
Thrombolytics or embolectomy
What are the components of Virchow's Triad that contribute to clot formation in DVT?
Stasis of blood flow, hypercoagulability, and endothelial injury
Which condition is NOT a potential cause of hypercoagulability in DVT?
Diabetes mellitus
Where does distal DVT commonly occur?
Popliteal vein
What complication of DVT presents with a congested bluish limb?
Phlegmasia cerulea dolens
Which scoring systems are commonly used to assess the likelihood of DVT or PE?
Wells Criteria and PERC score
What symptom distinguishes phlegmasia cerulea dolens from phlegmasia alba dolens?
Congested bluish limb
Which condition is a direct cause of stasis of blood flow in deep vein thrombosis (DVT)?
Prolonged travel
What is the main consequence of pulmonary embolism (PE) leading to obstructive shock?
Reduced right ventricular output resulting in hypoxemia
What is an example of endothelial injury that can contribute to clot formation in DVT?
Smoking
Study Notes
- Deep vein thrombosis (DVT) is characterized by the formation of blood clots (thrombus) in the veins, commonly affecting the legs.
- Proximal DVT occurs above the bifurcation, while distal DVT occurs below, with different veins like iliac, femoral, popliteal, tibial, and peroneal being involved.
- Virchow's Triad explains that stasis of blood flow, hypercoagulability, and endothelial injury contribute to clot formation in DVT.
- Factors leading to stasis include post-op states, paralysis, and prolonged travel, while endothelial injury can be caused by smoking and venous catheters.
- Hypercoagulability can be due to conditions like malignancy (pancreatic or lung), pregnancy, oral contraceptives, genetic mutations (Factor V Leiden), nephrotic syndrome, or antiphospholipid syndrome.
- Complications of DVT include phlegmasia cerulea dolens (congested bluish limb), phlegmasia alba dolens (pale limb due to arterial compression), post-thrombotic syndrome, and pulmonary embolism (PE).
- PE occurs when a clot breaks off from DVT and blocks a pulmonary artery, leading to symptoms like pleuritic chest pain, dyspnea, and hemoptysis.
- PE can cause respiratory failure due to VQ mismatch resulting in hypoxemia, and obstructive shock from reduced right ventricular output leading to hypotension and shock.
- Wells Criteria and PERC score are used to assess the likelihood of DVT or PE based on risk factors, symptoms, and history.
- Diagnostic tests for PE include chest x-ray (often normal), ECG (may show signs of right heart strain), D-dimer blood test, and imaging like CT pulmonary angiogram or VQ scan.
- Treatment for DVT depends on the location and severity, ranging from anticoagulation for distal DVT to thrombectomy or catheter-directed thrombolysis for massive proximal DVT.- To diagnose a pulmonary embolism (PE), different tests are used based on the patient's probability: CTPA or VQ scan for high probability, D-dimer with CTPA or VQ scan for moderate probability, and PERC score with D-dimer for low probability.
- CTPA is the preferred test in most cases to visualize clots in the pulmonary artery, while a VQ scan may show perfusion defects.
- If a PE is confirmed, further classification is needed: low-risk PE if echocardiogram shows no right ventricle (RV) dilation, and submassive/massive PE if RV dilation or dysfunction is present.
- The presence of low blood pressure indicates a massive PE burden, while normal blood pressure suggests a submassive PE.
- Treatment for PE varies based on hemodynamic stability: anticoagulation (Warfarin, Heparin, Xarelto, Apixaban) for stable patients, IVC filter if anticoagulation is contraindicated, and thrombolytics or embolectomy for hemodynamically unstable patients with massive PE.
- Prevention of venous thromboembolism involves pharmacological prophylaxis with LMWH or subcutaneous Heparin for immobile hospitalized patients, or mechanical compression devices if anticoagulants are unsafe.
Test your knowledge on Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), including risk factors, complications, diagnostic tests, and treatment options. Learn about Virchow's Triad, Wells Criteria, PERC score, imaging studies like CTPA and VQ scan, and management strategies for DVT and PE.
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